A Comprehensive Approach to Eliciting, Documenting, and Honoring Patient Wishes for Care Near the End of Life: The Veterans Health Administration's Life-Sustaining Treatment Decisions Initiative

Foglia, Mary Beth; Lowery, Jill; Sharpe, Virginia A.; Tompkins, P.C.; Fox, Ellen

doi:10.1016/j.jcjq.2018.04.007

Cited by 42 publications

(62 citation statements)

References 16 publications

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“…We illustrate the proposed method through its application in a UCD study to design feedback reports as part of a broader, large-scale audit and feedback intervention study [16]. The intervention was funded by the VA Quality Enhancement Research Initiative program in support of the Life-Sustaining Treatment Decisions Initiative, a United States Veterans Health Administration initiative led by the National Center for Ethics in Health Care to promote high-quality goals of care conversations (GoCCs) and documentation of patients' preferences for life-sustaining treatment [17,33].…”

Section: Resultsmentioning

confidence: 99%

“…Our objective is to propose a method for usercentered design of feedback reports that recognize relationships between refinements to audit (i.e., measurement) processes and feedback display. To illustrate the method, we describe a feedback report design process for a national initiative to implement goals of care conversations (GoCCs) for veterans in long-term care facilities and programs within the Veterans Health Administration [16,17]. The purpose of using feedback reports is to influence healthcare professionals and teams to adopt new practices and to identify opportunities for performance improvement.…”

Section: Introductionmentioning

confidence: 99%

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Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs

et al. 2020

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Background: User-centered design (UCD) methods are well-established techniques for creating useful artifacts, but few studies illustrate their application to clinical feedback reports. When used as an implementation strategy, the content of feedback reports depends on a foundational audit process involving performance measures and data, but these important relationships have not been adequately described. Better guidance on UCD methods for designing feedback reports is needed. Our objective is to describe the feedback report design method for refining the content of prototype reports. Methods: We propose a three-step feedback report design method (refinement of measures, data, and display). The three steps follow dependencies such that refinement of measures can require changes to data, which in turn may require changes to the display. We believe this method can be used effectively with a broad range of UCD techniques. Results: We illustrate the three-step method as used in implementation of goals of care conversations in long-term care settings in the U.S. Veterans Health Administration. Using iterative usability testing, feedback report content evolved over cycles of the three steps. Following the steps in the proposed method through 12 iterations with 13 participants, we improved the usability of the feedback reports. Conclusions: UCD methods can improve feedback report content through an iterative process. When designing feedback reports, refining measures, data, and display may enable report designers to improve the user centeredness of feedback reports.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs

et al. 2020

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“…Research has shown that addressing goals of care and what gives meaning to an individual's life are linked with higher quality outcomes and care. 39,40 By taking a holistic, interdisciplinary view and involving social workers early in the assessment and intake process, teams providing EOL care have reported more team cohesion and increased patient and family satisfaction. 41 Social workers often work with individuals who are vulnerable or have experienced marginalization through oppression and racism.…”

Section: Tip 4: Psws Have a Specialized Skill Set And Training To Promentioning

confidence: 99%

“…42 Culture may also interact or conflict with spiritual and religious beliefs, causing psychological distress. 40 By understanding patients' and families' unique spiritual and cultural journeys, PSWs honor diverse populations and their customs, rituals, and connection to community. 43 Effective PSWs bring their understanding that groups are distinguished by a set of rules that shape values, beliefs, habits, patterns of thinking, behaviors, and styles of communication.…”

Section: Tip 4: Psws Have a Specialized Skill Set And Training To Promentioning

confidence: 99%

“…43 Understanding that these values shape a patient's worldview is key to a PC team's ability to elicit and honor care preferences at the EOL. 40 In addition to cultural identity, in the absence of a PC teambased spiritual care provider, PSWs may be the most appropriate team member to assess spirituality needs. The World Health Organization has identified spirituality, the way individuals seek and express meaning and purpose in their lives, as an important aspect of QOL 43,44 and as a core dimension of health that intends to sustain distressed individuals.…”

Section: Tip 4: Psws Have a Specialized Skill Set And Training To Promentioning

confidence: 99%

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Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support

Farabelli

Kimberly

Altilio³

et al. 2020

Journal of Palliative Medicine

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Palliative care (PC) is perhaps the most inherently interdisciplinary specialty within health care. Comprehensive PC is delivered by a core team of physicians, nurses, social workers, spiritual care providers, pharmacists, and others who address the broad range of medical, psychosocial, and spiritual needs of those living with serious illness. While PC clinicians are typically skilled in screening for distress, the best path to follow when patients screen positive for psychosocial distress or exhibit mental health challenges may not always be clear. This article brings together the perspectives of experienced social workers practicing across PC and hospice settings. It seeks to identify opportunities and rationale for the integration of palliative social work (PSW) in the provision of quality, person-centered, family-focused, and culturally congruent care for the seriously ill. Increasing recognition of the impact of social determinants of health highlights the critical importance of including PSW if we are to better understand and ultimately address the broad range of factors that influence people's quality of life.

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Patient Characteristics Associated With Occurrence of Preoperative Goals-of-Care Conversations

et al. 2023

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ImportanceCommunication about patients’ goals and planned and potential treatment is central to advance care planning. Undertaking or confirming advance care plans is also essential to preoperative preparation, particularly among patients who are frail or will undergo high-risk surgery.ObjectiveTo evaluate the association between patient risk of hospitalization or death and goals-of-care conversations documented with a completed Life-Sustaining Treatment (LST) Decisions Initiative note among veterans undergoing surgery.Design, Setting, and ParticipantsThis retrospective cross-sectional study included 190 040 veterans who underwent operations between January 1, 2017, and February 28, 2020. Statistical analysis took place from November 1, 2021, to November 17, 2022.ExposurePatient risk of hospitalization or death, evaluated with a Care Assessment Need (CAN) score (range, 0-99, with a higher score representing a greater risk of hospitalization or death), dichotomized as less than 80 or 80 or more.Main Outcomes and MeasuresPreoperative LST note completion (30 days before or on the day of surgery) or no LST note completion within the 30-day preoperative period prior to or on the day of the index operation.ResultsOf 190 040 veterans (90.8% men; mean [SD] age, 65.2 [11.9] years), 3.8% completed an LST note before surgery, and 96.2% did not complete an LST note. In the groups with and without LST note completion before surgery, most were aged between 65 and 84 years (62.1% vs 56.7%), male (94.3% vs 90.7%), and White (82.2% vs 78.3%). Compared with patients who completed an LST note before surgery, patients who did not complete an LST note before surgery tended to be female (9.3% vs 5.7%), Black (19.2% vs 15.7%), married (50.2% vs 46.5%), and in better health (Charlson Comorbidity Index score of 0, 25.9% vs 15.2%); to have a lower risk of hospitalization or death (CAN score &lt;80, 98.3% vs 96.9%); or to undergo neurosurgical (9.8% vs 6.2%) or urologic surgical procedures (5.9% vs 2.0%). Over the 3-year interval, unadjusted rates of LST note completion before surgery increased from 0.1% to 9.6%. Covariate-adjusted estimates of LST note completion indicated that veterans at a relatively elevated risk of hospitalization or death (CAN score ≥80) had higher odds of completing an LST note before surgery (odds ratio [OR], 1.29; 95% CI, 1.09-1.53) compared with those with CAN scores less than 80. High-risk surgery was not associated with increased LST note completion before surgery (OR, 0.93; 95% CI, 0.86-1.01). Veterans who underwent cardiothoracic surgery had the highest likelihood of LST note completion before surgery (OR, 1.35; 95% CI, 1.24-1.47).Conclusions and RelevanceDespite increasing LST note implementation, a minority of veterans completed an LST note preoperatively. Although doing so was more common among veterans with an elevated risk compared with those at lower risk, improving proactive communication and documentation of goals, particularly among higher-risk veterans, is needed. Doing so may promote goal-concordant surgical care and outcomes.

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A Comprehensive Approach to Eliciting, Documenting, and Honoring Patient Wishes for Care Near the End of Life: The Veterans Health Administration's Life-Sustaining Treatment Decisions Initiative

Cited by 42 publications

References 16 publications

Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs

Designing clinical practice feedback reports: three steps illustrated in Veterans Health Affairs long-term care facilities and programs

Top Ten Tips Palliative Care Clinicians Should Know About Psychosocial and Family Support

Patient Characteristics Associated With Occurrence of Preoperative Goals-of-Care Conversations

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